Compassion Fatigue
Shoshin
No one in particularNowhere Special Veteran
I was at a community meeting earlier on today which was looking at the issues surrounding suicide, and a social worker present(There was a mixture of mental health professionals and a few lay people like my self) mentioned the dreaded "Compassion Fatigue" that many helpers/supporters can experience if they don't keep tabs on their mental wellbeing ...
A lot of Buddhism is about developing 'compassion', so when it comes to compassion fatigue...
Have you ever experienced it ?
How do/would you cope ?
What techniques have you developed to safe guard you ?
Even though a lot of my work involves empathy & compassion when dealing with people who are under a lot of stress, personally I don't have a problem with CF, I put this down to meditation practice, I've developed a balanced response, that is knowing when to let go and not becoming entangled in the client's emotional turmoil ...
For those who are unsure of what Compassion Fatigue is...Page 51 under title "Burnout"
Comments
Yes I have experienced it. But without doubt certain things that happen, enable it to return.
I used to be a social worker but experienced "burn out" around 15 years ago and never went back. I got very depressed and had a breakdown. Buddhist practice was of some help, though I wasn't in a state to practice effectively during that period anyway. I didn't feel I had much support from my employer, too little too late. In the UK the social work profession has come in for a lot of criticism over the years and morale is very low - that has meant problems with staff recruitment and retention, with many teams operating short-staffed which increases stress levels and further reduces morale.
Speaking on an extremely simplistic level, I am of the opinion that Compassion, cultivated in the Guise of Buddhist practice, along with other virtues (Brahma-Viharas) and in addition to adhering to other Buddhist tenets, is unlikely to lead to Compassion fatigue, because we also, alongside, learn the difference between Wise Compassion and Idiot compassion, and are aware of Impermanence, Clinging and Stress/suffering.
Presumably we also follow the Eightfold path, which gives us a far more comprehensive picture, and guideline on mental anguish.
A person practising Compassion (as @SpinyNorman did) and being unaware of the main premises of Buddhist teaching, will inevitably reach an imbalance, where their Compassionate and empathetic feelings will not be adequately counter-balanced by support, understanding and assistance, therefore, they will reach a level of exhaustion.
I'm sorry, @SpinyNorman, that things escalated to such a degree for you.
Also being in the UK, I am all-too-painfully aware also, of the current state of affairs within the Social Service sector. It is not a good time for people in such employment, particularly those who are loving, conscientious and compassionate, but who feel demoralised and frustrated by matters beyond their control.
As you must have.
Well put @federica and I have a shared experience with you @SpinyNorman, having worked in the UK medical profession; like the social work environment, there was no support network that I was ever aware of! I worked under great pressure, for many years, and am only now realising the toll it took on me.
I thought for a long time that practicing as a doctor was practicing compassion. That was idiot compassion.
Yes, Federica...nicely written!
It often seems like the social workers get more blame than the perpetrators of child abuse. Personally I don't think it's realistic to expect somebody to do this kind of intense draining work for a long period of time anyway. It would be good if people could have a complete break at regular intervals to recover emotionally, or be offered alternative employment or retraining after a period of time - but the system isn't set up like that.
I don't see things getting any better unfortunately. There seems to be a general culture of blame these days.
I can only speak about my experience with social workers who dealt with child abuse where I used to work here in the States. As a principal, there were always a few times every year that I had to call social services, or direct my subordinates to call social services about cases of suspected child abuse.
There was no consistency at all about how our notifications would be handled. Cases we thought were rather urgent were sometimes to virtually ignored. Cases we reported just to err way on the side of caution were often tacked aggressively. We were the ones that saw those kids every day and often knew the families. Social services sometimes seemed to be paper tigers.
I'm sure the social services department of which I'm speaking was overworked, and of course it's easy to complain about them. It was just the inconsistency in responses that bothered me very often.
Social Workers are in short supply, and demand is exceeding said supply. Social workers are being blamed for 'not spotting' certain traits earlier, or permitting certain situations to continue, but resources are few, funds even lower, and adequate man-power scant.
In addition to which, there are certain procedures, governed by law and regulations, which must be adhered to, and processes followed.
A social worker cannot gallantly gallop into any given situation and act in a manner to 'save the day'.
It just doesn't work like that, although I would bet many social workers wish it did.
It's no wonder that many things slip under the radar, wrongs are not righted and people get away with murder.
Match the manpower to the need, and you may just get somewhere.
But as things stand, case-loads are punishing, and it's a thankless task.
It seems to me that compassion that wears out, or burns a person out, isn't really compassion but a person trying too hard to force compassion where it might not have naturally blossomed yet. In fact, compassion works well to pull me out of burnout in the other areas of life.
I'd never heard the term before. I got burnt out some years ago. At the time I told myself that I was trying too hard to help people, but really it was about gratifying my own ego and boosting my self esteem through others' approval.
What we call compassion is a complex area and people's motives not always what they appear.
People may find this article interesting. The researcher differentiates empathy and compassion and her studies find that empathy alone is more akin to feeling the pain of another and thus adds to our suffering while true compassion reduces our stress level.
http://www.wired.co.uk/news/archive/2012-07/12/tania-singer-compassion-burnout
I agree with @poptart's direction. One of the very down-to-earth koans in Buddhism, I think, is the matter of "helping others." It's nice to play nice and it's nice to think I might lend a helping hand, but the truth of things lies closer to the fact that I do what I do and praise or blame -- for myself or others -- is where the burnout erupts.
Ahead of you on the sidewalk, an elderly woman falls down. Since you are closest, you instinctively lean down to give her a hand. You don't bother with "Buddhism" or "compassion" ... you just do it... end of story. Later someone may write a spiffy treatise about what they call "compassion," but things have moved on. Once you were kind and compassionate...now you may kick the dog.
A line the Dalai Lama once used and I like is this: "It can't be helped." The point of view may be a hard nut to crack, but Buddhism is all about cracking hard nuts, I think.
I remember as a young man, getting a job one year working at a nursing home while I was going to college. I had to quit after one year because of compassion fatique. In this case, they had one orderly (such as myself) working an entire hallway of rooms so we couldn't spend more than a few minutes with each resident, and the usual small percentage had severe mental problems and we had to fuss with them and try to feed them, etc.
By the end of the year, I resented those people. All I cared about was getting through a shift with a minimum of contact with them because five extra minutes talking to one lonely resident meant I was five minutes behind in my schedule. I started telling myself it wouldn't hurt to leave a man's dirty diaper on him for the next shift to handle. That sort of thing. So I had to quit. I didn't like what I was turning into.
And that was a normal reaction to stress. Our minds try to adapt to anything. I don't know how I'd react to the same job today. I have the same amount of compassion but perhaps a bit more wisdom and detachment of expectations.
I marked a couple 'insightful', but in truth, every post here is insightful.
This is a very important thread/topic for discussion and sharing experiences...and how Buddhism and being in the here and now can really help.
Powerlessness... recognizing what I am powerless over and letting go of it as soon as possible. This is how I maintain my balance.
But what if your job is to be compassionate?
But some pain cannot be alleviated, and you can't have compassion without empathy.
I think it's a sad reflection on our society that care-work is so undervalued. Minimum wage, under-staffing, profit before patients, etc.
Read the article, its fairly short. The idea is that compassion occurs on top of empathy.
http://www.wired.co.uk/news/archive/2012-07/12/tania-singer-compassion-burnout
And then, my personal experience when I'm in a situation that calls for empathy or compassion is that there's not even a question of my own ego's needs addressed at all.
It's the other person's needs that come uppermost before even considering my own mental distress.
But I can imagine compassion and empathy wearing thin when they are part of a job description, and the support network is lacking.
It can happen.
We outside shouldn't judge.
you have to take care of the center of your mandala. only then when you are bouyant can you truly help others
"Compassion fatigue" is not 'burn out', that was made clear in the exerpt. It's about secondary traumatic stress. It's about vicariously and empathically experiencing the suffering of the persons you work with. It's about YOU being affected by another person's suffering, co-experiencing it with them.
Sometimes I have flashbacks of other people's trauma. Flash-somethings, I dunno. This kind of reaction just happens, it's not a matter of 'taking care of yourself' or having a healthy company to work for or plenty of staff and resources. You can take good care of yourself the livelong day and it will do NOTHING to prevent or even help you prevent vicariously experiencing the suffering of whoever you are taking care of. It just happens, it goes in and then you have it too (albeit a more watery version).
Enough of those watery versions of other people's hideous, unspeakable suffering and you might as well be there yourself. It's a function of empathy, which IMO is a stand-alone quality you have, like a talent or aptitude.
I have to go back to work (as a nurse) and every day of my life I dread it, it feels like a kind of condemnation. I didn't just come up with this out of a 'mood', I've been struggling with it for MONTHS now. Is that compassion fatigue? Mid-life crisis? It's become difficult for me to see much BUT suffering, and I don't mean my own. Going back to a nursing job feels like going back into the arena. I am SO TIRED. I feel like this on a good day.
in the brahmaviras a near enemy of compassion is 'overwhelm'. for the brahmaviras if one doesn't work you go to the next. The next after overwhelm is 'mudita' or joy. So you try to take joy in some moments to uplift you out of the overwhelm. All the 4 brahmaviras work the next in the sequence. If you have near enemy of sympathetic joy of addiction to these 'uplifts' then the next one along is upekka or letting the 'uplifts' come and go.
I haz hard shell.
Taking refuge is not a joke. Give all the negative stuff to the Buddha. He has hell realms to feed.
As we increase the capacity for bodhicitta (we lucky people) so we must develop the wisdom to balance this with appropriate responses.
“For even as love crowns you so shall he crucify you. Even as he is for your growth so is he for your pruning. Even as he ascends to your height and caresses your tenderest branches that quiver in the sun, so shall he descend to your roots and shake them in their clinging to the earth.”
― Khalil Gibran, The Prophet
If it is part of your job to be compassionate and you no longer can, then it is time to move on, as Cinorjer said in his story.
It is my understanding (though I certainly don't understand it in detail, but my teacher has covered the topic) that one should develop the ability to be able to not fully take on the suffering of others if they are going to be in careers like that. One can (and most people should) practice compassion, even great compassion, without taking in the suffering of those people. It is just like anything else. If it harms you to try to help someone, you are not necessarily doing something good. Causing harm to yourself is still causing suffering and it does little good to alleviate suffering while causing suffering. If you are compassionate to the point you are taking on the suffering of others without proper training on how to do so, that isn't much different from other forms of attachment.
@Cinorjer's post doesn't hit close to home for me, it IS home. I am ashamed of having those exact same intentions, whether or not I allowed them to manifest. I've punished myself, I think, for loathing that call bell ("honey I have to pee") the moment my butt hits the chair so I can chart
. At the same time I'm thinking human neurology drives these unwholesome intentions, so going hard on myself isn't as thorough as it could be.
I feel like the top of my head is rebounding off of the next level of awareness I've yet to break through to. It's a little bit sore banging against it. In no way do I believe my current dilemma is permanent or 'just the way things are', I am a Buddhist after all.
I believe 'something more' is there . . . right there. There. Can't see it, in the same way astrophysicists can't 'see' dark matter, just infer it's presence by its effects on everything around it. Bang bang bang, let me in!! I mean out!
Thank you, really, for responding to my post. I read @Shoshin's first post last night and the excerpt. It pissed me off (the excerpt) because I am beyond tired of reading about 'the solution' because nothing anyone says can possibly solve what must be experienced, and that experience is under pressure. It feels like all I can do is wait for that organic 'flowering' of awareness to pierce and illuminate the next step. Bang bang bang!!
.
@Hamsaka the first sentence in my post above was meant to be a reply to @SpinyNorman but I forgot to tag him, sorry about that!
I know what Cinorjer means, and you, too. I am not a nurse, I never could be. But I do a lot of care taking for my elderly grandma who lives next door and I've had some awful thoughts and many days of low patience and lack of compassion. Days I see her number come up on my phone and I don't want to answer it. There is no quitting. My issue with her is not compassion burnout or stress or anything like that, it's resentment towards the rest of my family who are close by. She is their mother, and they do not help her. So my frustration at their lack of care towards her comes out as frustration towards her, unfortunately. It's a good (and ongoing, lol) lesson for me, though, and for her, too. Despite the difficulties I know I won't regret having spent the time with her. The things that get annoying some days, will be funny memories later
Like yesterday when I took her shopping and she waved her cane at a man in the store and screamed at him, heh.
If it's your job to be "compassionate", is that really compassion?
Is what compassion? Not sure what you mean.
@karasti : hey, if she shoe fits . . .
For the OP: Joan Halifax of the Upaya Zen center talks about 'compassion fatigue' in this On Being podcast
When I am done with me
I thinks about others.
Only loving
what reflects back on me.
Tired I iz
Of life and change.
All in all
Nothing moves me.
On.
Is what compassion? Not sure what you mean.
Okay, I was a school principal. I was expected to do things for students (for example) that could be considered compassionate. But since I was being paid to do such things as related to my job, I never thought that as demonstrating compassion.
Now, if I went way beyond the call of duty, that might be different.
Here's a youtube clip on Cultivating Compassion in the Clinician-Patient Interaction by Roshi Joan Halifax...
My first contact with her teaching was when I found an article by her on Mudita =Sympathetic Joy....
A good question. I think generally people go into caring professions for good reasons but sometimes being compassionate to order just isn't feasible.
"The Road to hell is paved with good intentions (reasons)."
And who creates the Hell we find ourselves in?
All is Mind, and Awareness.
Referring to my previous post, on the difference between Buddhist and non-Buddhist Compassion, when we are unaware, circumstances conspire.
When we become Aware, we realise our perceptions need attending to, first and foremost.
We can't have compassion without a sense of empathy but empathy doesn't always have the benefit of nurtured compassion. If proof of that is needed just watch America's Funniest Home Videos, lol.
"Oh you can tell that hurt, hahaha" goes the host.
I work in a retirement home and have put time in a long term care facility so I know exactly where @Cinorjer is coming from and have seen people get too caught up in their empathy and the sadness of others that their compassion gets skewed. One guy came in happy to be there and ready to help and within a month started to resemble Eeyore from Winnie The Pooh. His residents started to suffer more and treat him badly until he had to leave 2 weeks before his school placement ended.
The thing about compassion is until you can really show it to yourself, you won't really be able to show anyone else.
OK. I don't differentiate between 'expected' acts of compassion and over-and-above acts of compassion. They are ALL optional, whether or not it is a specific requirement of your job description or something spontaneous. To differentiate between them, to me, is reductionism of the act of compassion itself. Who cares if its part of your job description, or if you get more or less points on your yearly eval based on you executing particular 'compassionate' behaviors? Compassion is its own thing in spite of context -- this is the way I see it, not saying anyone is right or wrong.
I read this article - twice - but have serious objections in that actually it is not really a study, rather it is just her ('Singers') opinion, based on what, really? - Objectivity if you are going to take this kind of thing to a scientific level, is important, and is pretty much absent in this article @person... please be more mindful in your presentation of what you may believe to be factual representations.
Yeah, rereading the article I guess it is short on study details. I was previously acquainted with her research and I didn't really see how others might read it.
The article does give a brief summary of what she studied:
...As a result, Singer is working on a study to help people learn to become more compassionate. Using techniques that centre on compassion or the Buddhist notion of loving-kindness, Singer and colleagues have managed to shift participants' brain activity to cause less activation in areas of the brain supporting negative feelings about themselves. In the early stages of training, participants seem to show more empathy, but with more training this shifts so that their brain activity more closely resembles the expert meditators'.
Here's a link to her research institute page:
http://www.cbs.mpg.de/staff/singer-11258/@@index.html?v=publications-selected&sm=type_year&order=dsc#articles
If you want something more detailed and specific you can probably dig up something there.
I agree, but I'm not sure how that relates to compassion fatigue.
I think it's a misnomer and would be better served with the label empathy fatigue to avoid confusion.
Taking on too much of the pain of others without healing yourself will surely lead to some kind of overload.
I know this is going to sound all Buddhisty, but the "Middle Way" comes to mind-the path between two extremes.....
And finding the "Middle Way" is what the Dharma's all about....
Alan Watts
I totally agree. What kind of healing? From what I'm hearing and beginning to understand is that it starts with the body, keeping the body well taken care of, which means a lot more than a good diet and exercise. In vipassana meditation we are asked where and what we experience in the body, which in some lines of thought says we 'store' trauma at a physical level, gross matter level. Yoga is supposedly a direct way to bring the body and mind into a single unit to be dealt with.
This has been a very, very helpful thread for me, timely too.
I seem to remember from my social work days that there are ways of allowing the pain of others to dissipate, rather than hanging on to it. But if you're tired and stressed it's harder to do that effectively. The only other option I can see is not to empathise in the first place, ie to keep the suffering of others at a distance.
For me it isn't about dissipation but inner transformation. In my job I have to find the middle way or I can't be effective.
I have to empathize and at the same time remain objective. The other night for example a resident fell and had hit her head. There was blood on the carpet about the size of a dinnerplate and she was afraid of going to the hospital. I had to calm her down and of course send her on her way. I would not have been able to calm her down if I kept at a distance because she trusts me to be there. As she should. It is not only my duty but my job. I also had to remain objective or I may not have sent her to the hospital as I caved to her fear.
To be objective, I cannot remain at a distance. I have found I have to let my being there for their suffering be the inner transformation of suffering to healing of myself.
Another resident I cared for passed away a few days before. I was laughing and bonding with him not a week and half ago. Down the hall is someone that needs me to fully be there for them. I transform my suffering to healing and walk in that room with a smile.
The middle path serves me well and I wouldn't even have chosen that career shift without it.
I used to work production in Toronto's music and entertainment industry while fixing trucks on the side. Then I lost the three people closest to me.
Now I party with the dying while raising a new family... How the wheel turns.
@SpinyNorman I think @ourself and I are on the same page about this. The research the article I posted earlier was pointing to the idea that our options are actually three or maybe four. First, there is a type of emotional resonance, a type of mirror neuroning that is instinctual. Then there is an empathizing with another's pain where we ourselves begin to suffer. The option you give is one they talk about where empathizing can lead to aversion and even anti-social behavior. The findings and conclusion of the research though is that if the empathizing with another's pain then gives rise to an internal feeling of warmth and compassion then instead of other's suffering giving rise to our own pain it gives rise to our internal feelings of warmth. It is through practicing compassion meditation that we may strengthen this reaction and reduce compassion or empathy fatigue.